Healthcare Provider Details

I. General information

NPI: 1083145353
Provider Name (Legal Business Name): PATSY BURKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SAINT CHARLES BLVD
SHREVEPORT LA
71106-8540
US

IV. Provider business mailing address

420 SAINT CHARLES BLVD
SHREVEPORT LA
71106-8540
US

V. Phone/Fax

Practice location:
  • Phone: 318-469-6940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: